Medical power of attorney in Iowa: how it works, how to sign
The short answer
In Iowa, a durable power of attorney for health care names someone to make medical decisions when you can't. It must be dated and signed before two qualifying witnesses or an Iowa notary. Without one, Iowa's default list (spouse, adult children, parents, siblings, other relatives, then a close friend) covers only end-of-life decisions.
The question under every medical power of attorney is a simple one. If you can't speak for yourself, who talks to the doctor?
Iowa calls the document a "durable power of attorney for health care," and the person you name is your "attorney in fact." This page covers how to sign one, who can't be your witness, how a living will fits in, and what happens if you name nobody. It is part of our state guides to estate planning. For the basics of the role, see what a medical power of attorney is.
How do I sign one in Iowa?
The document must say plainly that it authorizes your agent to make health care decisions for you, and it must be dated (Iowa Code 144B.3). Then it needs one of these:
- Two witnesses, who watch you sign and sign in the presence of each other and of you, or
- An Iowa notary, before whom you acknowledge your signature.
Iowa publishes an optional statutory form (Iowa Code 144B.5). You don't have to use it. A document valid where you signed it is honored in Iowa.
That signing rule is different from Iowa's financial power of attorney, which must be notarized and needs no witnesses. Our Iowa power of attorney guide covers that document.
Who can't be my witness, or my agent?
Iowa rules out a few people (Iowa Code 144B.3, 144B.4):
| Person | Can be a witness? | Can be your agent? |
|---|---|---|
| A health care provider attending you on the day you sign | No | No |
| An employee of that provider | No | No, unless a close relative |
| The person you name as your agent | No | Yes |
| Anyone under 18 | No | Not applicable |
| A relative within the third degree (for example a sibling, niece or nephew) | Yes, but at least one witness must not be related | Yes |
| A friend or neighbor who is none of the above | Yes | Yes |
The easiest path for most people is a notary. If you use witnesses, pick at least one friend or neighbor who isn't related to you.
What can my agent decide?
Your agent makes the health care decisions you would make if you could. In daily terms that usually means talking with your doctors, reading your chart, and agreeing to or declining a test, a surgery or a new medicine in light of your wishes.
A good document doesn't just name a person. It tells them what matters to you, so they aren't guessing in a hospital hallway.
Do I need a living will too?
Many people sign both. A health care power of attorney names a person. A living will writes down your wishes about treatment.
In Iowa the living will is called a "declaration" about life-sustaining procedures (Iowa Code 144A.3). It works only if you are in a terminal condition and can't make treatment decisions. It is signed and dated, then either:
- Witnessed by two adults, in the presence of each other and you. At least one must not be related to you within the third degree, and neither can be an attending health care provider or the provider's employee, or
- Acknowledged before an Iowa notary.
The statute includes an optional form. Our post on health care power of attorney vs living will explains how the two work together, and treatment preferences helps you think through what to write.
Who decides if I haven't named anyone?
This is where Iowa is unusual. Iowa has no general law naming a default decision-maker for all medical care. Its default list covers end-of-life decisions only: withholding or withdrawing life-sustaining procedures for a patient in a terminal condition who can't communicate and has no declaration (Iowa Code 144A.7). A 2026 law, House File 2305, extended it to hospice admission and resuscitation in facilities.
For those decisions, your attorney in fact or a court-appointed guardian decides first. If there is none, the decision goes to whoever is reasonably available, willing and competent, in this order (as updated by House File 2305):
| Order | Who decides |
|---|---|
| 1 | Your spouse |
| 2 | Your adult children (a majority of those reasonably available) |
| 3 | Your parents (both, if both are available) |
| 4 | Your adult brothers and sisters (a majority) |
| 5 | A majority of other adult relatives reasonably available, such as grandchildren, nieces, nephews, aunts, uncles and stepfamily |
| 6 | A close adult friend |
Can a close friend serve? Yes, since House File 2305, at the bottom of the list. The friend must be 18 or older, have shown special care and concern, keep regular contact, and know your health, activities and beliefs. They must also give your provider an affidavit saying they are willing and able to be involved. Older articles show the list ending at siblings, with no friend at all.
The decision also needs written agreement between your attending provider and a second physician, nurse practitioner or physician assistant, with a witness present.
For everyday medical decisions outside that end-of-life list, Iowa's statute names nobody. That gap is the best reason to sign a document. Our post on medical decisions without a power of attorney compares other states, and the 50-state guide to default decision-makers has the full picture. Our short who decides for me tool can help you see where you stand.
Here is a typical case, a composite. Susan is 73, divorced, and lives in Cedar Rapids. Her only brother lives in Arizona. Her neighbor Mary drives her to appointments and knows what she would want. Susan names Mary as her health care agent, with her brother as backup.
How do I choose my agent?
Once the signing is done, the practical questions matter most. A short checklist:
- They know what you want, because you've told them.
- They can stay calm in a hospital hallway and ask questions.
- They live close enough, or can travel when needed.
- You've named a backup in case they can't.
Our post on how to choose a medical power of attorney has more questions to ask.
Some people would like a professional standing by, first or behind a friend. A Kinly membership includes a medical power of attorney written for your state, and Trella Trust Company can be named in the role, first or as the backup to someone you choose.
When your health papers are done, our Iowa probate guide covers what happens to your home and savings later.
Common questions
Does a medical power of attorney need to be notarized in Iowa?
No. It can be acknowledged before an Iowa notary or signed before two witnesses. If you use witnesses, at least one must not be related to you within the third degree.
Can my doctor be my health care agent in Iowa?
Not if they are attending you. An attending health care provider, or their employee unless a close relative, can't be named as your agent. They also can't serve as witnesses.
Who makes medical decisions in Iowa if there's no power of attorney?
For end-of-life decisions in a terminal condition, Iowa's list runs from spouse to adult children, parents, siblings, other adult relatives, then a close friend. For other medical decisions, the statute names nobody.
Can a friend make medical decisions for me in Iowa without a document?
Only at the end of the list, for end-of-life decisions, and only with an affidavit to the provider. Naming your friend in a durable power of attorney for health care puts them first.
Is there an official Iowa form?
Yes. Iowa publishes optional statutory forms for the durable power of attorney for health care and the living will declaration. You don't have to use them.
Sources
- Iowa Code 144B.1: Definitions (Iowa Legislature)
- Iowa Code 144B.3: Execution of durable power of attorney for health care (Iowa Legislature)
- Iowa Code 144B.4: Restrictions on who can be attorney in fact (Iowa Legislature)
- Iowa Code 144B.5: Statutory form (Iowa Legislature)
- Iowa Code 144A.3: Declaration relating to life-sustaining procedures (Iowa Legislature)
- Iowa Code 144A.7: Procedure in absence of declaration (Iowa Legislature)
- 2026 Iowa Acts, chapter 1071 (House File 2305), enrolled (Iowa Legislature)
This page is general information, not legal or financial advice. Laws vary by state.